Outline

Question: to evaluate the frequency of paroxysmal atrial fibrillation episodes, management strategy and efficacy of treatment on pre-hospital stage.

Methods used: This retrospective study was performed using emergency department archives of one of the city outpatient’s clinics for the year 2005.

Results: Paroxysmal atrial fibrillation was the cause of 518 emergency calls in 2005. It made 7.9 per cent of the total emergency calls for all causes and 61.6 per cent of the calls for cardiac rhythm disturbances. 22 episodes of atrial fibrillation were stopped before the arrival of the ambulance. In most of the cases it was the result of oral IC, II, III antiarrhytmic drugs taking by the patients as an attempt to stop the arrhythmia. First detected episodes of atrial fibrillation were registered in 74 cases of the total 518 or 14.3 per cent. Pre-hospital management of atrial fibrillation depended on the duration of the arrhythmic episode. In case of AF less than 6 hours and if there were no contraindications pharmacological cardioversion with procainamide was performed. Procainamide was effective in 124 of 178 cases, or 69.7 per cent. In 6.1 per cent there were complications: arterial hypotension, transformation to atrial flutter or conduction disturbances. If AF continued more than 6 hours or its duration was unknown the patients were admitted to hospital without any attempt of cardioversion. In case of rapid AF digoxin, verapamil or obsidian were administered for ventricular rate control.

Conclusion: Paroxysmal atrial fibrillation caused 7.9 percent of the total emergency calls and 61.6 percent of the emergency calls for cardiac rhythm disturbances. Procainamide efficacy for cardioversion in atrial fibrillation less than 6 hours was 69.7 per cent.